Impact of Type 2 Diabetes Mellitus and Antidiabetic Medications on Bone Metabolism
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PEDIATRIC TYPE 2 AND MONOGENIC DIABETES (O PINHAS-HAMIEL, SECTION EDITOR)
Impact of Type 2 Diabetes Mellitus and Antidiabetic Medications on Bone Metabolism Hae Sang Lee 1 & Jin Soon Hwang 1 Accepted: 26 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review focuses on the complex interactions between hyperglycemia and bone fragility and the effects of antidiabetic medications on bone metabolism. Recent Findings Type 2 diabetes (T2D) is associated with increased risk of bone fracture even in those with increased or normal bone mineral density (BMD). The pathophysiology of diabetic bone disease is not completely understood, but it is thought to be multifactorial and associated with complex cross talk among factors such as AGEs, IGF-1, enteric hormones, and proinflammatory cytokines. Treatment for T2D may have an impact on bone metabolism. Summary Diabetic bone disease should be considered a serious complication of long-standing T2D. Keywords Type 2 diabetes . Osteoporosis . Bone remodeling . Fracture
Introduction Type 2 diabetes mellitus (T2D) is a major health problem and one of the most prevalent chronic diseases. In 2019, 463 million people (9.3% of adults 20–79 years old) were living with T2D worldwide. The estimated number of people (20– 79 years) living with T2D has increased by 62% over the past 10 years [1]. Moreover, the increasing prevalence of childhood obesity is a worldwide problem [2]. The prevalence of T2D has more than doubled in children and adolescents in the past 10 years [3]. Diabetes and its complications are a major cause of morbidity and mortality and result in increased economic burden. T2D can affect many different organ systems in the body and, over time, can lead to serious complications including nephropathy, neuropathy, retinopathy, and cardiovascular disease. Recently, the increased risk of fragility fractures has been recognized as an important complication in diabetics; This article is part of the Topical Collection on Pediatric Type 2 and Monogenic Diabetes * Jin Soon Hwang [email protected] 1
Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Ajou University Hospital, San 5, Wonchon-dong, Yeongtong-gu, Suwon 443-721, Korea
although, paradoxically, the bone mineral density (BMD) in those with T2D is higher than in non-diabetic subjects [4]. In this review, we described the complex interactions between hyperglycemia and bone and the effects of antidiabetic medications on bone metabolism.
Bone Mineral Density and the Prevalence of Fractures in Type 2 Diabetes Although the prevalence of T2D in children and adolescents has increased dramatically in past decades, there have been few reports on bone metabolism in pediatric patients with T2D. In a study by Lee et al. [5], the BMD of the lumbar spine and total body in adolescents with new T2D was not different compared to obese controls without T2D, but the BMD of the femoral neck was significantly lower than in controls. In adults,
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